I’m a Texan. But I don’t know if I can be a Texas OB-GYN

This story first appeared on Courier Texas

Texans don’t give up easily, and I’m a Texan. I’m in my second year of medical school in Texas, and I’m studying to be an OB-GYN.

I grew up in Texas, and I’m open-minded about staying in the state to practice obstetrics and gynecology after I graduate, despite the laws that ban most abortions from conception. A lot of the people that I love are in Texas, and there’s this big draw to stay here because it’s my community. I really want to care for other women.

But what worries me most about practicing here is that I won’t be able to provide certain types of care because of the laws. I worry about the moral distress I’ll feel if I’m unable to act in particular cases—especially in emergency situations when a woman might need a termination and the law says that you can’t do one.

On the other hand, I feel that there is a great deal of value in staying in Texas to practice after I graduate from medical school because of my upbringing.

There is value in having a doctor who understands the culture. I think we need people who know how to talk to women who may have grown up in a similar environment to the one I did. I grew up in a really conservative religious family—a megachurch community.

My family not only strongly opposed abortion, but really didn’t give me any information about sexual or reproductive health either. That’s why I feel a great deal of gratitude to the physicians and nurses that took care of me and answered questions that my family didn’t. 

My views have become very different from those of my parents and siblings. It was my interest in bioethics that led to changes in my views. I saw that pregnancy is very complicated. Having a kid is not without risk.

The Dobbs decision changed everything

I remember that I was out on a run through the city where I live, listening to music, when the Supreme Court’s Dobbs decision, ending the Constitutionally protected right to an abortion, was leaked. There was a big crowd of women on the street watching the news about the decision on a big screen. A whole bunch of them were crying and I just stood there crying with people that I didn’t know.

I had already been surprised a year before, when the Texas legislature had passed a 6-week abortion ban—the law Senate Bill 8, which used bounty hunters to sue doctors providing abortions.

But after the Dobbs decision—which overturned Roe v. Wade in 2022—I really worried what this would mean for the women of Texas. And it’s not just a hypothetical worry about the future. Women have died and women will continue to have really morbid, terrible outcomes because of these abortion laws. More women will die.

I know there are so many doctors who are very committed to staying in Texas and to taking care of Texas women and will do everything they can to make sure that their patients are safe. 

As a doctor, I want to be able to provide the care that my patients need. I’ve seen that there’s a lot more nuance in medicine than the law captures in Texas.

When I spent time in a maternal fetal medicine unit, there was a patient who suffered from an autoimmune disease called lupus. This woman was doing a routine ultrasound when her fetus was diagnosed with Potter’s Sequence.

The baby had no kidneys, and without kidneys, a baby’s lungs won’t develop.

Editor’s Note: The fetus’s kidneys produce amniotic fluid, and without amniotic fluid, a baby’s lungs won’t develop.

Because the baby wouldn’t develop lungs, it was incompatible with life—it would suffocate to death after birth.

Then the mother’s own kidneys started to fail. Her pregnancy was making her extremely ill. She was too sick to drive to another state for an abortion and then she went into kidney failure. It was really heartrending.

 Eventually, she got the care she needed, but it was delayed and delayed. It’s cases like this one that make me question my next steps.

There are ways that you can work with or advocate with the legal or ethics team at your hospital to get your patient care. But it’s intimidating to think that the care that I would be able to offer people after my training would be altered by the law.

That’s one of the reasons why I don’t know yet whether I will actually stay in Texas.

Editor’s Note: A new law in Texas, the Life of the Mother Act, allows for abortions to be done if, in a physician’s “reasonable medical judgment,” a pregnant patient is suffering from a “life-threatening condition.”

I value my Texas education, but worry about the future

There are also personal considerations. I have a partner who is in medical school as well, but a couple of years ahead of me. It will depend on which hospital and city he ends up working in as a resident doctor. Hopefully I will follow him because I would obviously like to live in the same place.

Right now, having a family isn’t an immediate priority, but I do worry that if I was pregnant in Texas and had a complication, I wouldn’t get the standard of care that I needed.

As for the medical training to be an OB-GYN that I am getting in Texas, I feel like I’m at a medical school where I’m being holistically educated within the bounds of the Texas law.

The faculty are very supportive. I feel confident that mentors at my institution will make sure that I’m doing month-long “away” rotations—stints at medical schools in abortion-legal states—to learn what I can’t be taught in Texas.

Also, through conferences in other parts of the country and through conversations I have with them outside of lectures, I still feel that I’m going to get the education I need to be an OB-GYN.

I know that I will probably have to be a little more creative than peers in other states where abortion is legal.

I’m OK with that. Obviously, I would prefer abortion care be part of my curriculum. Like, we shouldn’t have to work outside of school to learn something that’s really essential to caring for 50% of the population.

The problem with the “away” sessions is that you have to pay for them yourself, and they are very expensive. Plus, you have to take out student malpractice insurance for the particular state that you are in and it’s on you to figure out how to pay for this with your loans.

I want to be an advocate for Texas patients

Last summer, I was working doing research in a state where abortion is legal and people were shocked when they heard that I was from Texas. They’d say, “Oh my God! Why would you be there? Why would you stay there?”

Well, it’s a huge financial decision to leave Texas to go to medical school. It’s about a quarter of the cost for medical students to stay in Texas when we are residents here.

So if people leave, it’s asking more from you than just leaving behind your home and your loved ones—it’s also asking students to take on much more debt, when we already have a lot.

If I do end up staying in Texas to practice as an OB-GYN, it’s because I want to contribute to change and to advocate for my patients. One of the things that would motivate me to stay is that I believe that there is a capacity to make change here.

I don’t think it’s going to happen quickly, but there are people who are working very, very hard to make change and to make sure that all Texan women can get access to reproductive health, including abortion. I wish our Texas legislature had different priorities.

Texas ‘grit’ is inspiring, but my future remains uncertain

We already have so many disparities in our maternal and child health care in Texas.

And not just in obstetric care, but also for women that develop postpartum depression or women who have substance abuse disorders and then get pregnant while trying to kick their substance abuse problem.

And we don’t have enough providers as it is to take care of them. It’s worse if you live in a rural area—even worse if you live in poverty and it’s even worse than that if you’re undocumented.

So we already had a problem, and the abortion bans amplify the problem for people who are already the most vulnerable.

Editor’s Note: Maternal mortality soared 56% in Texas between 2019 and 2022, after the state passed its first abortion ban, SB8. This is compared to a rise of 11% nationwide. Infant deaths also jumped 13% in the year after the passage of SB8.

Right now, my job is to be the best medical student I can be. Just learn medicine well, because at the end of the day that’s the skill I need more than any other.

A lot of the people teaching me have made a commitment to stand with their students, no matter what the future holds in our state.

One unintended consequence of the abortion bans in our state is that it has raised the political awareness among many medical students in Texas in a way that might not have existed before.

I’ve been overwhelmed in a really positive way by the number of medical students who have said they were motivated to go to medical school by the abortion bans.

I have a lot of peers who are deeply committed to learning how to take care of our patients and advocating for everybody to have access to abortion and contraception, so they outweigh the negative.

I’m inspired by the grit it takes to keep going, because it’s really hard in Texas.

I just wish my decision about where I end up practicing as an OB-GYN didn’t have to be further complicated by having to consider the law.